Remnant Ratio Research Articles

Radiation lobectomy: Time-dependent analysis of future liver remnant volume in unresectable liver cancer as a bridge to resection

Portal vein embolization (PVE) is a standard technique for patients not amenable to liver resection due to small future liver remnant ratio (FLR). Radiation lobectomy (RL) with (90)Y-loaded microspheres (Y90) is hypothesized to induce comparable volumetric changes in liver lobes, while potentially controlling the liver tumor and limiting tumor progression in the untreated lobe. We aimed at testing this concept by performing a comprehensive time-dependent analysis of liver volumes following radioembolization. 83 patients with right unilobar disease with hepatocellular carcinoma (HCC; N=67), cholangiocarcinoma (CC; N=8) or colorectal cancer (CRC; N=8) were treated by Y90 RL. The total liver volume, lobar (parenchymal) and tumor volumes, FLR and percentage of FLR hypertrophy from baseline (%FLR hypertrophy) were assessed on pre- and post-Y90 CT/MRI scans in a dynamic fashion. Right lobe atrophy (p=0.003), left lobe hypertrophy (p<0.001), and FLR hypertrophy (p<0.001) were observed 1 month after Y90 and this was consistent at all follow-up time points. Median %FLR hypertrophy reached 45% (5-186) after 9 months (p<0.001). The median maximal %FLR hypertrophy was 26% (-14 → 86). Portal vein thrombosis was correlated to %FLR hypertrophy (p=0.02). Median Child-Pugh score worsening (6 → 7) was seen at 1 to 3 months (p=0.03) and 3 to 6 months (p=0.05) after treatment. Five patients underwent successful right lobectomy (HCC N=3, CRC N=1, CC N=1) and 6 HCCs were transplanted. Radiation lobectomy by Y90 is a safe and effective technique to hypertrophy the FLR. Volumetric changes are comparable (albeit slightly slower) to PVE while the right lobe tumor is treated synchronously. This novel technique is of particular interest in the bridge-to-resection setting.

A new ratio for better predicting future death/myocardial infarction than standard lipid measurements in women &gt;50 years undergoing coronary angiography: the apolipoprotein A1 remnant ratio (Apo A1/ [VLDL3+IDL

BackgroundWomen often lag behind men in their risk of cardiovascular events. However, with age and the onset of menopause, women’s cardiovascular risk eventually becomes similar to that of men. This change in risk may, in part, be attributable to a shift to a more atherogenic lipid profile. Our objective was to evaluate standard- and sub-lipid parameters and the apo A1 remnant ratio: (apo A1/[VLDL3-C+IDL-C]) for their associations with death/myocardial infarction among peri- and post-menopausal women.MethodsWomen (N=711) >50 years of age undergoing coronary angiography were evaluated. Baseline clinical and angiographic characteristics, lipids, and sub-lipid levels (Vertical Auto Profile method) were collected. Cox regression analysis, adjusted by standard cardiovascular risk factors, was utilized to determine associations of lipid and sub-lipid tertiles(T) with death/myocardial infarction at 1 and 3 years.ResultsPatients averaged 67.7±9.4 years and 53.6% had underlying severe (≥70% stenosis) coronary artery disease. The apo A1 remnant ratio was found to have stronger associations for 1 year (T1 vs. T3: HR=2.13, p=0.03, T2 vs. T3: HR=1.57, p=0.21) and 3 year (T1 vs. T3: HR=2.32, p=0.002, T2 vs. T3: HR=1.97, p=0.01) death/myocardial infarction than any individual lipid (LDL-C, HDL-C, triglycerides, non-HDL-C) or sub-lipid (apo A1, apo B, VLDL3-C+IDL-C) measure, or any other well-known ratio (triglyercies/HDL-C, apo B/A1, TChol/HDL-C, HDL-C/[VLDL3-C+IDL-C]).ConclusionsThe apo A1 remnant ratio was a significant predictor of short and intermediate-term death/myocardial infarction risk among women >50 years of age. Furthermore, this ratio was found to have greater predictive ability than traditional lipid and sub-lipid parameters and represents a potential new risk marker.

2:42 PM Abstract No. 205 - Portal vein embolization for two-stage hepatectomy in patients with colorectal liver metastasis: safety, efficacy, and value of including segment 4

Purpose To examine the efficacy and safety of portal vein embolization (PVE) on future liver remnant (FLR) hypertrophy when used between the first and second stage of two-stage hepatectomy (TSH) in patients with colorectal liver metastases (CLM). Secondary purpose was to evaluate the effect of extending right portal vein embolization (RPVE) to segment 4 (RPVE + 4) on hypertrophy of segments 2 + 3 (S2 + 3). Materials and Methods IRB-approved retrospective cohort study performed from May 1998 to January 2011. Fifty-one patients with CLM underwent PVE as an adjunct to TSH; RPVE was performed in 16 and RPVE + 4 was performed in 35. Absolute FLR volumes, standardized future liver remnant (sFLR) ratios, degree of hypertrophy (DH), and complications were recorded and analyzed with t-tests. To assess the value of extending RPVE to segment 4 in the setting of TSH, absolute volumes and DH were measured for S2 + 3 for all 51 TSH patients. All volumetric measurements were compared to a control cohort composed of 96 patients (n = 37 RPVE, n = 59 RPVE + 4) in whom PVE was performed as an adjunct to single stage hepatectomy (SSH) during the same time period. Results For patients who completed RPVE as an adjunct to TSH (n = 16/16), absolute FLR volume increased from 268.3 mL to 427.3 mL (p Conclusion PVE is an effective and safe technique to induce a significant DH in the FLR prior to definitive stage 2 hepatectomy. Unlike SSH, extending RPVE to RPVE + 4 for TSH does not appear to induce a significant hypertrophy of S2 + 3 volumes.

A simple model for the fate of the cytokinesis midbody remnant: Implications for remnant degradation by autophagy

When a cell divides, it produces two daughter cells initially connected by a cytokinesis bridge, which is eventually cut through abscission. One of the two daughter cells inherits a bridge "remnant", which has been proposed to be degraded by autophagy. The fate and function of remnants is attracting increasing attention, as their accumulation appears to influence proliferation versus differentiation of the daughter cells. Here, we present a simple model for bridge and remnant turnover in a dynamic cell population. We demonstrate that remnant proportions depend on the ratio of remnant and bridge lifetimes to the cell population doubling time. Our results yield new alternative interpretations for published experimental data, leading us to believe that autophagy-independent pathways for remnant degradation may exist. In addition, using the model, we determined experimentally inaccessible parameters such as remnant lifetime. Our model proves to be a useful tool for studying bridge and remnant populations.

Anomalous Magnetization Behavior of Fe-N Films Deposited by Reactive Pulsed Laser Deposition

A series of Fe-N films with thickness of 200 nm have been prepared by reactive pulsed laser deposition (PLD) at 25°C and at 150°C in various nitrogen pressures. Both series of samples consist of mixtures of γ'-Fe 4N and α-Fe phase. The amount of α-Fe decreases with the increase of nitrogen pressure. Higher remnant ratio and lower coercivity are observed for the films deposited at 150°C compared to the films deposited at 25°C. An anomalously large magnetization is observed for both series of films deposited at a nitrogen pressure of 8 mTorr. The average magnetization is as high as or even larger than that of α-Fe. Conversion electron Mossbauer spectroscopy demonstrated that the highest-magnetization film consists mixtures of γ'-Fe4N and α-Fe phase at a mole ratio of 1:6. The origin of this intriguing high moment is ascribed to a certain lattice constant of the α-Fe which is in a heterogeneous state with γ'-Fe4N for films deposited at a certain nitrogen pressure.

Ratio of remnant to total liver volume or remnant to body weight: which one is more predictive on donor outcomes?

BackroundRight lobe donations are known to expose the donors to more surgical risks than left lobe donations. In the present study, the effects of remnant volume on donor outcomes after right lobe living donor hepatectomies were investigated. MethodsThe data on 262 consecutive living liver donors who had undergone a right hepatectomy from January 2004 to June 2011 were retrospectively analysed. The influence of the remnant on the outcomes was investigated according to the two different definitions. These were: (i) the ratio of the remnant liver volume to total liver volume (RLV/TLV) and (ii) the remnant liver volume to donor body weight ratio (RLV/BWR). For RLV/TLV, the effects of having a percentage of 30% or below and for RLV/BWR, the effects of values lower than 0.6 on the results were investigated. ResultsComplication and major complication rates were 44.7% and 13.2% for donors with RLV/TLV of ≤30%, and 35.9% and 9.4% for donors with RLV/BWR of < 0.6, respectively. In donors with RLV/TLV of ≤30%, RLV/BWR being below or above 0.6 did not influence the results in terms of liver function tests, complications and hospital stay. The main impact on the outcome was posed by RLV/TLV of ≤30%. ConclusionRemnant volume in a right lobe living donor hepatectomy has adverse effects on donor outcomes when RLV/TLV is ≤30% independent from the rate of RLV/BWR with a cut-off point of 0.6.

Synthesis and surface modified hard magnetic properties in Co0.5Pt0.5 nanocrystallites from a rheological liquid precursor

Small crystallites of a metastable phase Co0.5Pt0.5 are precipitated by heating a rheological liquid precursor of cobalt–hydrazine complex and platinum chloride H2PtCl6·xH2O in polymer molecules of poly(vinylpyrrolidone) (PVP) in ethylene glycol. The hydrazine co-reduces nascent atoms from the Co2+ and Pt4+ that recombine and grow as Co0.5Pt0.5. The PVP molecules cap a growing Co0.5Pt0.5 as it achieves a critical size so that it stops growing further in given conditions. X-ray diffraction pattern of a recovered powder reveals a crystalline Co0.5Pt0.5 phase (average crystallite size D∼8nm) of a well-known Fm3m-fcc crystal structure with the lattice parameter a=0.3916nm (density ρ=14.09g/cm3). A more ordered L10 phase (ρ=15.91g/cm3) transforms (D≥25nm) upon annealing the powder at temperature lesser than 700°C (in vacuum). At room temperature, the virgin crystallites bear only a small saturation magnetization Ms=5.54emu/g (D=8nm) of a soft magnet and it hardly grows on bigger sizes (D≤31nm) in a canted ferromagnetic structure. A rectangular hysteresis loop is markedly expanded on an optimally annealed L10 phase at 800°C for 60min, showing a surface modified coercivity Hc=7.781kOe with remnant ratio Mr/Ms=0.5564, and Ms=39.75emu/g. Crystallites self-assembled in an acicular shape tailor large Hc from ideal single domains and high magnetocrystalline anisotropy of a hard magnet L10 phase.

Preoperative Percutaneous Transhepatic Portal Vein Embolization With Ethanol Injection

The purpose of this article is to evaluate the feasibility and efficacy of preoperative percutaneous transhepatic portal vein embolization with ethanol injection. We retrospectively evaluated 143 patients who underwent percutaneous transhepatic portal vein embolization. Hypertrophy of the future liver remnant was assessed by comparing the volumetric data obtained from CT image data before and after percutaneous transhepatic portal vein embolization. The evaluation of effectiveness was based on changes in the absolute volume of the future liver remnant and the ratio of the future liver remnant to the total estimated liver volume. Ten of 143 patients (7.0%) underwent additional embolization because of recanalization and insufficient hypertrophy of the future liver remnant. The mean increase in the ratio of the future liver remnant was 33.6% (p < 0.0001), and the mean ratio of future liver remnant to total estimated liver volume increased from 34.9% to 45.7% (p < 0.0001). Although most of the patients complained of pain after ethanol injection, they were gradually relieved of pain in a few minutes by conservative treatment. Fever (38-39°C) was reported after 47 of 151 (31.1%) percutaneous transhepatic portal vein embolization sessions and was resolved within a few days. Transient elevation of the liver transaminases was observed after the procedures and resolved within about a week. Major complications occurred in nine of 151 (6%) percutaneous transhepatic portal vein embolization sessions, but no patients developed hepatic insufficiency or severe complications precluding successful resection. One hundred twenty patients underwent hepatic resection, and two patients developed hepatic failure after surgery. Preoperative percutaneous transhepatic portal vein embolization with ethanol is a feasible and effective procedure to obtain hypertrophy of the future liver remnant for preventing hepatic failure after hepatectomy.

Quantitative Evaluation of Liver Function with Use of Gadoxetate Disodium–enhanced MR Imaging

To determine whether liver function correlating with indocyanine green (ICG) clearance could be estimated quantitatively from gadoxetate disodium-enhanced magnetic resonance (MR) images. This retrospective study was approved by the institutional review board, and the requirement for informed consent was waived. Twenty-three consecutive patients who underwent an ICG clearance test and gadoxetate disodium-enhanced MR imaging with the same parameters as were used for a preoperative examination were chosen. The hepatocellular uptake index (HUI) from liver volume (V(L))and mean signal intensity of the liver on contrast-enhanced T1-weighted images with fat suppression (L(20)) and mean signal intensity of the spleen on contrast-enhanced T1-weighted images with fat suppression (S(20)) on 3D gradient-echo T1-weighted images with fat suppression obtained at 20 minutes after gadoxetate disodium (0.025 mmol per kilogram of body weight) administration was determined with the following equation: V(L)[(L(20)/S(20)) - 1]. The correlation of the plasma disappearance rate of ICG (ICG-PDR) and various factors derived from MR imaging, including HUI, iron and fat deposition in the liver and spleen, and spleen volume (V(S)), were evaluated with stepwise multiple regression analysis. The difference between the ratio of the remnant HUI to the HUI of the total liver (rHUI/HUI) and ratio of the liver remnant V(L) to the total V(L) (rV(L)/V(L)) was evaluated in four patients who had segmental heterogeneity of liver function. HUI and V(S) were the factors significantly correlated with ICG-PDR (R = 0.87). The mean value and its 95% confidence interval were 0.18 and 0.01 to 0.34, respectively, for the following calculation: (rHUI/HUI) - (rV(L)/V(L)). The liver function correlating with ICG-PDR can be estimated quantitatively from the signal intensities and the volumes of the liver and spleen on gadoxetate disodium-enhanced MR images, which may improve the estimation of segmental liver function.

A New Ratio for Better Predicting Future Death/Myocardial Infarction than Standard Lipids in Women &gt;50 Years Undergoing Coronary Angiography: The Apo A1 Remnant Ratio (Apo A1/[VLDL3+IDL])*

Synopsis: Women often lag behind men in their cardiovascular (CV) disease risk. However, with age and the onset of menopause, a women’s CV risk eventually becomes similar to that of men. This change in risk may, in part, be attributable to a shift in a more atherogenic lipid profile, in particular remnant lipoproteins (VLDL3 + IDL). Therefore, determining lipid parameters that predict risk is essential. Thus, we evaluated standard lipid parameters, apolipoprotein (apo) A1, and the apo A1 remnant ratio: (apo A1/ [VLDL3 + IDL]) for their associations to death (D) or myocardial infarction (MI) among periand post-menopausal women. Purpose: To evaluate the clinical utility of the new apo A1 remnant ratio compare with standard lipid measurements in predicting future D/MI in women older than 50 years undergoing coronary angiography. Methods: Women (n 5 711) older than 50 years of age from the Intermountain Heart Collaborative Study who were undergoing coronary angiography were evaluated. Baseline clinical and angiographic characteristics, lipid levels (determined by hospital’s clinical laboratory), and sublipid particles (determined with the Vertical Auto Profile method) were collected. Lipid and sublipid parameters were evaluated as tertiles (see supplemental material). Cox regression analysis, adjusted by standard CV risk factors, was used to determine associations of lipid and sublipid particles with D/MI at 1 and 3 years (average length of follow-up: 3.9 6 2.1 years). Results: Patients averaged 67.76 9.4 years and 53.6%had underlying severe (.70% stenosis) coronary artery disease.Mean lipid measurements (mg/dL) were high-density lipoprotein: 48.3 6 15.6, low-density lipoprotein: 106.7 6 37.3, nonhigh-density lipoprotein: 136.5 6 41.3, apo A1: 119.7 6 20.3, and apoA1/(VLDL3+IDL): 6.66 3.6. Because triglycerides were non-normally distributed, median level is reported: 133.0mg/dL. Sublipidparticleswere the best predictors of short (1 year) and intermediate (3 year)D/MI risk. These associations persisted evenafter adjustment.The strongest predictor ofD/MI risk at both time-points was the apo A1 remnant ratio: apo A1/ (VLDL3+IDL). Conclusions: The newparameter, the apoA1 remnant ratio, is a strong predictor of short-term and intermediate D/MI risk amongwomenolder than 50years of age. Furthermore, this ratio has a greater predictive ability than traditional lipid parameters and apo A1. This apo A1 remnant ratio represents a potential new measurement of risk and treatment target and should be tested in a larger cohort among this population, periand postmenopausal women, and other populations.

Low temperature pulsed laser deposition of textured γ′-Fe 4N films on Si (1 0 0)

Low-temperature reactive pulsed laser deposition (PLD) was used to prepare iron nitride films. The textured γ′-Fe 4N films with (0 0 1)-orientation were deposited on Si (1 0 0) substrate with Fe buffer layer at a substrate temperature as low as 150 °C. The (0 0 1)-oriented γ′-Fe 4N film grew on the Fe buffer layer with a 3.5-nm thick amorphous interlayer, which eliminated the lattice mismatch stress between them. The films showed a columnar granular morphology with an average lateral grain size of approximately 110 nm. The films exhibited good soft magnetic properties with a high in-plane M r / M s value of 0.84. The magneto-optic Kerr effect results indicated an in-plane magnetic isotropy and confirmed the high remnant ratio of the γ′-Fe 4N films.

Synthesis of polysilisiquioxane used as core layer material of optical waveguide

Colorless and transparent polysilisiquioxane was synthesized using non-hydrolytic sol–gel process. A high degree of poly-condensation and a lower remnant ratio of Si–OCH3 were calculated by 29Si NMR and 1H NMR, respectively. After spin-coating, subsequently UV and thermal curing, free-cracked thin films were obtained. The properties of the free-cracked thin films were measured by a prism coupler and thermal analysis system. The refractive index increased to 1.5495 (1,310 nm TE) and 1.5468 (1,550 nm TE), respectively, with the increasing of phenyltrimethoxysilane content to 20 mol%. Birefringence was below 0.0005. The thermo-optic coefficient was about −2.8 × 10−4 °C−1. The optical loss was 0.20 dB cm−1 at 1,310 nm and 0.75 dB cm−1 at 1,550 nm, which was very important for core layer material of optical waveguide. The results of Thermo-Gravimetric Analysis indicated an excellent thermal stability. All of these properties imply that it will be a promising core layer material of optical waveguide.

MAGNETIC PROPERTIES OF FENI NANOWIRE ARRAYS ASSEMBLED ON POROUS AAO TEMPLATE BY AC ELECTRODEPOSITION

FeNi nanowire arrays were fabricated into the pores of porous alumina template by a simple alternating current electrodeposition method in this work. FeNi nanowires with different diameters were obtained depending on the pore size arrangement of alumina templates. FeNi nanowire arrays exhibited obviously magnetic anisotropy, and the easy axis was along the nanowires. When the applied magnetic field was parallel to the nanowires, the coercivity (Hc) and the maximum remnant ratio (Mr/Ms) are considerable higher than those while the magnetic field perpendicular to the nanowires. FeNi nanowires prepared in this work are expected to be utilized as the perpendicular magnetic recording media. The magnetic domain structure and the magnetizing mechanism of FeNi nanowires were also been discussed.

Synthesis of Ni Nanochains with Various Sizes: The Magnetic and Catalytic Properties

A series of pure Ni thin chains with particle diameters ranging from 15 to 80 nm were successfully synthesized by a wet chemical method. Magnetization measurements for the Ni chains reveal that the saturation magnetization increases and the coercivity decreases with increasing particle diameter. The magnetization reversal mechanism of both the samples with a diameter of 30 and 50 nm can be described by the model of “chain of spheres”. Using the fanning mode, the calculated coercivities and the remnant ratios agree well with the experimental results. Surprisingly, the coercivity is greatly enhanced, reaching as high as 790 Oe at T = 5 K for the Ni chains with a diameter of ∼15 nm, which are composed of single-crystal particles. Meanwhile, in the degradation of pentachlorophenol (PCP) solutions with Fe0 nanoparticles as reducing agents, Ni nanochains with a diameter of ∼80 nm were added, and the results indicate that the sample could serve as a good catalyst in dechlorination systems.

Synthesis of nano-Cd xZn 1− xS by precipitate-hydrothermal method and its photocatalytic activities

A novel and simple chemical approach involved in precipitate-hydrothermal processes is described to synthesize nanocrystalline CdS, ZnS and Cd x Zn 1− x S. The as-prepared samples were characterized by XRD, SEM, PL and UV–vis diffuse reflectance spectroscopy. The lattice structure gradually changes from hexagonal to cubic with increasing percentage of Zn in the ternary compound Cd x Zn 1− x S. The UV–vis and PL spectra indicate that the optical properties of the obtained nanocrystals can be continuously modulated by tuning their compositions. Cd x Zn 1− x S also showed the high photocatalytic activity in degradation of methyl orange under visible light, and the remnant ratio is 3–13% for 1 h.

A multistep ac electrodeposition method to prepare Co nanowires with high coercivity

It is known that the ac electrodeposition method with low current density can grow compact metal nanowires, but the length of those nanowires is very short. In contrast, the ac electrodeposition method with high current density can grow long metal nanowires. However these long nanowires are not compact and contain lots of defects. In this paper, we describe a multistep ac electrodeposition method to fabricate long metal nanowires with compact structure uniformly filled upon a porous anodic aluminum oxide template. Using this method, Co nanowires with high coercivity (Hc∥) and remnant ratio (Mr/Ms) have been prepared under relatively low deposition current density. The Co nanowires exhibited obvious magnetic anisotropy with the easy axis along the axial direction of nanowires. The maximal Hc∥ (2900 Oe) and Mr/Ms (0.95) were optimal for the perpendicular magnetic recording materials. The magnetic microstructure of Co nanowires is also discussed in this paper.

Characterization and magnetic property of carbon coated metal nanoparticles and hollow carbon onions fabricated by CVD of methane

This work focuses on the structural characterization and magnetic property of carbon onions, which were synthesized via catalytic decomposition of methane over Ni/Al catalyst. The results showed that the small microcrystalline planar is 3.2 nm for the obtained carbon onions according to calculation from Raman. The saturation magnetization at room temperature of the carbon onions is 27.12 emu/g, which is 53% of the bulk ferromagnetic element counterpart due to the inclusive phases of carbon and magnetic effect of small particles with larger surface to volume ratio. The coercive force at room temperature of the carbon onions is 141.6 Oe, while the ratio of remnant to saturation magnetization M r/ M s is about 0.247.

Clinical outcomes of EMR for gastric tumors: historical pilot evaluation between endoscopic submucosal dissection and conventional mucosal resection

EMR is currently a standard treatment for mucosal gastric tumors. Endoscopic submucosal dissection (ESD) has been developed for en bloc resection. We evaluated the clinical outcomes of ESD compared with conventional EMR. Not applicable. A historical control study was performed between EMR and ESD. EMR of 245 gastric tumors was performed in 229 patients. Lesions were divided into two groups. Conventional EMR was performed in group A from February 1999 to June 2001, and ESD was performed in group B from July 2001 to March 2004. Group B was divided into subgroups: subgroup B-1 underwent ESD from July 2001 to March 2003 and subgroup B-2 from April 2003 to March 2004. All lesions were resected with conventional EMR or with ESD. En bloc resection rate, rate in completeness of resection, required time, remnant ratio, and complications were evaluated. With regard to lesions >10 mm in size, the en bloc resection rate and the rate in completeness of resection of group B was significantly higher than that of group A (p < 0.01). Although the required time was longer in group B than A (p < 0.01), it was shorter in subgroup B-2 compared with B-1 (p < 0.05) with lesions < or =10 mm in size. The remnant ratio and perforation rate were not different between groups. Not applicable. The en bloc resection rate was better with ESD than with conventional EMR. The required time was longer in ESD, but this disadvantage might be improved with experience.

Assessment of hepatic reserve for indication of hepatic resection: how I do it

Hepatic resection may result in liver failure in patients with cirrhotic livers. Preoperative evaluation of liver function in cirrhotic patients, to prevent postoperative liver failure, is very important. Sixteen patients with hepatocellular carcinoma in cirrhotic livers were enrolled in this study. Liver function was determined quantitatively by monoethylglycinexylidide (MEGX) formation from the metabolism of lidocaine. The whole liver volume and tumor volume were measured by computed tomographic volumetry. The volume of resected liver was recorded by water displacement. The relationship between liver function and remnant liver volume was determined. A relationship between the percentage remnant liver volume and ratio of MEGX formation after hepatectomy was found. The regression equation was: (postoperative MEGX formation/preoperative MEGX formation) x 100% = (0.688 x percentage remnant liver volume + 0.179) x 100% (r (2) = 0.49). A relationship between MEGX formation after hepatectomy and the international ratio (INR) of prothrombin time was also found. The regression equation was INR = 1.99 - 0.01 x MEGX (r (2) = 0.30). Post-hepatectomy liver function can be estimated for an individual patient by the appropriate regression equations. Prevention of post-hepatectomy liver failure for patients with cirrhotic livers is feasible.

Evaluation of liver function for hepatic resection for hepatocellular carcinoma in the liver with damaged parenchyma

Background Liver functional parameters, including the Child—Pugh score and indocyanine green clearance (ICG), and volumetric parameters influencing postoperative liver function were evaluated with the aim of obtaining standardardized criteria for selecting patients for, and deciding the extent of, hepatectomy for hepatocellular carcinoma (HCC). Materials and methods The study population consisted of 120 patients with HCC undergoing hepatic resection excluding those with more than 3000 ml of intraoperative bleeding. Patients were classified as grades A, B, or C on the basis of, respectively, a Child—Pugh score of 5 or 6, 7–9, or ≥10 and were assigned to group D (postoperative liver dysfunction) or group N (no complication). Postoperative complications included massive ascites, pleural effusion, or hyperbilirubinemia. For each grade, the standardized estimated liver remnant ratio (STELR) was determined as the ratio of the liver remnant volume (estimated by computerized tomography) to the standardized total liver volume (STLV), estimated from the body surface area using the equation: liver volume [cm 3] = 706 × body surface area [m 2] + 2.4. The ICG retention rate at 15 min after injection (ICGR15) was then plotted against the STELR for each grade and a demarcation line separating patients in groups N and D was determined statistically by discriminant analysis. Results For grade A patients, the equation of the demarcation line was ICGR15 = 27.5 × STELR + 1.9 (Wilks’ Lambda: 0.667, P < 0.001), indicating that, for safe hepatic resection in patients with an ICGR15 of 10%, the STELR should be greater than 0.29. In contrast, for grade B patients, the equation was ICGR15 = 72 × STELR − 22.1 (0.589, P < 0.001), indicating that, in patients with a 10% ICGR15, the STELR should be greater than 0.44, a larger value than in grade A patients. The number of grade C patients was too small for analysis. Conclusions By combining the Child—Pugh score, ICG clearance, and liver volumetric parameters, criteria for the selection of patients for hepatic resection for HCC were established.